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PubMed1996

Constipation in an elderly community: a study of prevalence and potential risk factors.

OBJECTIVE: The epidemiology of chronic constipation in the elderly remains poorly defined. We aimed to study the prevalence of, and potential risk factors for, constipation in a representative elderly community, using symptom-based diagnostic criteria. METHODS: An age and gender-stratified random sample of 1833 eligible residents of Olmsted County, Minnesota, aged 65 yr and over, was mailed a valid self-report questionnaire; 1375 responded (75%). RESULTS: The overall age- and gender-adjusted prevalence (per 100) of any constipation was 40.1 (95% CI 38.9, 44.4); for functional constipation and outlet difficulty or delay, the prevalence rates were 24.4 (95% CI 22.0-26.9) and 20.5 (95% CI 18.2-22.8), respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Outlet delay, but not functional constipation, was more frequent in women; functional constipation, but not outlet delay, was associated with advancing age. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. CONCLUSIONS: In independently living, elderly persons, constipation is a common complaint; among these subjects, there appear to be symptom subgroups that can be identified.

Age Distribution↗
PubMed1996

Papillomatous digital dermatitis in 458 dairies.

OBJECTIVE: To estimate prevalence of papillomatous digital dermatitis (PDD) in California dairies during 1993, to describe temporal and spatial patterns of PDD and response of cows to treatment, and to evaluate herd-related risk factors for PDD. DESIGN: Epidemiologic survey. SAMPLE POPULATION: All southern California dairies and a 50% random sample of the rest of California dairies. PROCEDURE: A questionnaire was mailed to managers of 1,429 selected dairies. RESULTS: Prevalence of PDD during 1993 was significantly higher for dairies in the south (75.3%) and central (68.8%) regions, compared with north coast (33.3%) and north (23.1%) regions of the state. Herd mean and median proportions of affected cows in PDD-affected herds were 11.6 (SEM = 0.9) and 5%, respectively. Most (74%) dairy managers surveyed observed PDD for the first time during 1992 or 1993. Highest PDD activity was reported as taking place in summer in the south and in fall and winter in the north coast and north regions; an obvious pattern was not determined for the central region. CLINICAL IMPLICATIONS: PDD was widespread in California dairies during 1993 and affected a high proportion of cows, especially in the south and central regions of the state.

Animals↗
PubMed2005

Active and passive smoking and risk of renal cell carcinoma in Canada.

This study aimed to assess the role of active and passive smoking in the development of renal cell carcinoma (RCC). Mailed questionnaires were completed by 1279 incident RCC cases and 5370 population controls between 1994 and 1997 in eight Canadian provinces. Data were collected on socio-economic status, smoking habits, diet and passive smoking status, as well as residential and occupational history. The study found an increased risk of RCC associated with active smoking. Elevated risk of RCC was also observed with passive smoking; compared with those never exposed to either passive or active smoking, men and women with 43 or more years of passive residential and/or occupational exposure had respective adjusted Odds Ratios (ORs) of 3.9 (95% Confidence Interval (CI) 1.4-10.6) and 1.8 (95% CI 1.0-3.3) (P=0.001 and P=0.09, respectively). Both active and passive smoking might play a role in the aetiology of RCC.

Adult↗
PubMed2003

Onset of natural menopause in African American women.

OBJECTIVES: This study assessed predictors of the onset of natural menopause in African American women. METHODS: We used mailed questionnaires to collect data at baseline in 1995 and during follow-up from Black Women's Health Study participants. Cox proportional hazards regression was used to assess potential predictors-including experiences of racism-of the onset of natural menopause among 17 070 women aged 35 to 55 years and premenopausal in 1995. RESULTS: The hazard ratio (HR) was 1.43 for current smokers (95% confidence interval [CI] = 1.24, 1.66) and 1.21 (95% CI = 1.06, 1.38) for ex-smokers and significantly less for obese women and oral contraceptive users. Hazard ratios for most questions about racism were elevated by 10% to 30% but were not statistically significant. CONCLUSIONS: Earlier onset of natural menopause among African American women is strongly associated with smoking and inversely associated with body mass index and oral contraceptive use.

Adult↗
PubMed2006

Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients--a randomised study of nurse versus psychologist interventions.

OBJECTIVE: In a prospective, randomised study, individual psychosocial support performed by: (1) specially trained oncology nurses (INS) or (2) psychologists (IPS) were compared with respect to utilisation, satisfaction and perceived benefit. METHODS: Between December 1997 and December 1999, consecutive breast cancer patients (n=120) were included at start of adjuvant therapy (chemo-, endocrine and/or loco-regional radiotherapy). Data were collected by an extended version of the 'IPS-patient satisfaction questionnaire' within 1 week after termination of the support intervention. Questionnaires were also mailed to all patients 6, 12 and 18-24 months after inclusion. Levels of distress were collected with the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) questionnaires. RESULTS: The patients were highly satisfied with the individual psychosocial support intervention they received, irrespective of which profession provided the support. However, the patients in the INS group reported higher levels of benefit regarding disease-related problems, regardless if the patients at baseline reported low or high levels of distress. CONCLUSIONS: Patients were highly satisfied with an individual psychosocial support intervention. In areas dealing with somatic aspects, the group intervened by nurses were more satisfied than the one by psychologists. PRACTICE IMPLICATIONS: Individual psychosocial support by specially trained nurses is a realistic alternative in routine cancer care.

Adaptation, Psychological↗
PubMed2002

Physician interactions with families and caregivers after a patient's death: current practices and proposed changes.

There are little objective data concerning physician bereavement or other supportive interactions with the families and caregivers of deceased patients. We surveyed the physician staff of a large tertiary rural referral center in central Pennsylvania. We asked about current practices in attending former patients' funerals, family condolence visits, letter or phone contacts, as well as the desire of physicians to participate in these activities. The database consisted of 143 questionnaires that were returned from 286 physicians initially mailed the survey. Only 119 of the 143 had experienced patient deaths in their practices. Most of these 119 physicians did not participate in any type of planned contact with a former patient's family after the patient's death. Phone calls were used 39.6% after an inpatient death, and condolence notes were sent by about 40% of physicians. There was no correlation between these activities and number of deaths in the practice per year or if death occurred as an inpatient or outpatient. Physicians practicing at the medical center more than 10 years were more likely to contact the grieving family or caregivers. There was significant desire by the physicians to have an easy way to identify deceased patients' caregivers or loved ones, to have condolence notes available for the physicians' use, and to have bereavement service information sent to the families or caregivers.

Attitude to Death↗
PubMed2006

The relationships between uncertainty and posttraumatic stress in survivors of childhood cancer.

The purposes of this study were to understand the levels of uncertainty and posttraumatic stress and to examine their relationships in young adult survivors of childhood cancer. A cross-sectional correlational design was used in this study. Mailed survey was the data collection method. The Mishel Uncertainty in Illness Scale-Community Form was the measure of uncertainty. The University of California at Los Angeles Post Traumatic Stress Disorder Index was the measure of posttraumatic stress. A total of 46 (51.1%) survivors responded to the survey and the analysis was based on data from 45. Participants reported a mean 51.3 (SD = 14.5, range = 23 to 90) level of uncertainty; and a mean 15.7 (SD = 11.0, range = 0 to 43) level of posttraumatic stress. Uncertainty was positively correlated with posttraumatic stress (r = .40, p = .039). The re- conceptualization of the Uncertainty in Illness Theory (UIT) and developmental perspectives can explain the relationships between uncertainty and posttraumatic stress in the young adult survivors of childhood cancer. The re-conceptualization of UIT can serve as a guide for future studies.

Adaptation, Psychological↗
PubMedDate not supplied

Comparison of appropriateness ratings for cataract surgery between convened and mail-only multidisciplinary panels.

BACKGROUND: In this article, the authors determine the reproducibility of appropriateness ratings for cataract surgery between a multidisciplinary physician panel that convened and a multidisciplinary physician panel that completed ratings by mail. METHODS: Eighteen panelists, who constituted 2 distinct multidisciplinary panels, rated 2894 clinical scenarios as an appropriate, inappropriate, or uncertain indication to perform cataract surgery. Each panel's summary score for each scenario was calculated. Weighted kappa values were determined to assess the level of agreement between the ratings of the 2 panels. RESULTS: The panels had a substantial level of agreement overall, with a weighted kappa statistic of 0.64. There was agreement on about 68% of the scenarios, and serious disagreement, in which one panel rated an indication appropriate and the other rated it inappropriate, occurred in only 1% of the ratings. CONCLUSION: There was substantial agreement about the ratings by the 2 panels. The panel that convened rated fewer scenarios uncertain and more appropriate, suggesting the impact of group dynamics and face-to-face discussion on resolution of uncertainty.

Cataract Extraction↗
PubMed2001

The health-line--a method for collecting data on self-rated health over time: a pilot study.

BACKGROUND: There is a need for an instrument to record a life-course perspective of self-rated health. AIM: To test the "health-line", a simple, comprehensive method of collecting data on self-rated health over time. METHOD: In 1996, a questionnaire was mailed to people who in 1985 were aged between 25 and 34 years old and had a sick-leave spell >28 days with "back diagnoses". They were asked to rate their global health graphically with a "health-line" for the years 1985-95. Official data on sick leave and disability pension were obtained for the same period. In all, 37 out of 52 men and 60 out of 83 women answered; that is, they drew a health-line. RESULT: A statistically significant negative correlation between the mean number of absence days due to ill health and the health-line data was found for every year (r= -0.35 to -0.53; p<0.001) and for the whole period 1985-95 (r=-0.546; p<0.001) respectively. CONCLUSION: The method worked well and is well worth further development and testing.

Adult↗
PubMed2004

Gender differences in chronic pain--findings from a population-based study of Norwegian adults.

The purpose of this study was to evaluate for gender differences in the experience of chronic pain and the impact of chronic pain on quality of life (QOL). A total of 1,912 out of 4,000 Norwegian citizens returned a mailed questionnaire, and 24.4% reported chronic pain. More women than men reported chronic pain, and women reported significantly higher pain intensity scores than men did. Although the duration of chronic pain was similar in women and men, women more often received treatment for their chronic pain. Men in chronic pain reported a poorer QOL than women did. Although specific variables that predicted present pain intensity in women and men differed, the variables that explained the largest percentage of the variance in pain for both genders were the disease and the pain location variables. These findings support previously published studies that document gender differences in chronic pain and extend the work to the impact of chronic pain on QOL.

Adult↗
PubMedDate not supplied

Tuberculosis risk in the hospital dental practice.

Tuberculosis has re-emerged as a serious public health concern. Multidrug-resistant strains and an increase in the number of high-risk groups are posing a difficult problem for health care providers. The risk of TB transmission in hospital dental practices is potentially increasing. A 20-question survey was mailed to the membership of the American Association of Hospital Dentists, addressing various issues relating to tuberculosis. One hundred thirty-two surveys were analyzed. Twelve per cent of respondents reported at least one TB skin test conversion by a dental provider within the past year at their institution. Five respondents reported one dental provider contracting TB through patient contact. Oral TB was reported in 21 cases. Over 34% reported that active TB patients are not isolated to negative-pressure isolation rooms, 45% reported that patients are allowed to frequent public areas, and only 59% believed that drug compliance monitoring was adequate. Over 86% support TB screening in the Hospital Dental Practice. It was concluded that Hospital Dental Practice personnel may be at increased risk for exposure to TB. Dental providers must exercise strict TB prevention and employ meticulous referral and follow-up procedures for high-risk patients.

Chi-Square Distribution↗
PubMed1993

Asthma risk and occupation as a respiratory therapist.

In the modern hospital environment, many health care workers are exposed to hazardous substances. Among these hazards are respiratory sensitizers, irritants, and infectious agents. A previous cross-sectional study of Rhode Island respiratory therapists reported an excess risk of asthma after entry into that profession. Before the results of that study were published, we conducted a confirmatory mailed questionnaire survey of 2,086 Massachusetts respiratory therapists and 2,030 physical therapists and physical therapy assistants. Neither the survey questionnaire nor the accompanying cover letter revealed the focus of our investigation. A history of physician-diagnosed asthma was reported by 16% of respiratory therapists and 8% of control subjects. When analysis was restricted to those who developed asthma after entry into their profession, respiratory therapists still had a significant excess, 7.4 versus 2.8%. The odds ratio for respiratory therapy was 2.5 (95% Cl, 1.6 to 3.3) after adjustment for age, family history, atopic history, smoking, and gender. These results confirm the previous report of excess risk of asthma among respiratory therapists. This excess risk develops after entry into the profession and does not appear to be explained by bias or confounding. Efforts should be directed to identifying potential agents responsible for this form of occupational asthma.

Adult↗
PubMedDate not supplied

Changes in body weight and fat mass of men and women in the first year of college: A study of the "freshman 15".

Students entering their first year of college are faced with many stresses and changes, including changes in eating and exercise behavior. A common but often undocumented myth among college students is that there is a high risk of gaining 15 pounds of weight during freshman year. The objective of this study was to measure changes in body weight and percentage of body fat among first-year college students. Using a digital scale with bio-electrical impedance, the authors measured height, weight, and percentage of body fat for a sample of students who volunteered to be weighed during a health assessment in the university dining halls. The authors sent e-mails inviting those same students to complete a second measurement in February of the academic year. Sixty-seven of the 217 students who volunteered for the health assessment agreed to undergo a second set of measurements in the spring. The mean change in body weight was 2.86 pounds (1.3 kg, SD = 4.0 kg), and the mean change in percentage of body fat was 0.7% (SD = 4.0%). For those students who gained weight only, the mean increase in body weight (as measured by body mass index, weight divided by height in kg/m2) was 6.82 pounds (3.1 +/- 2.4 kg) and percentage of body fat was 0.9 +/- 3.8%. The authors found that the first year of college is a period in which weight and fat gain may occur. The exact causes behind these changes are unclear and warrant further research to plan or improve intervention and prevention.

Adult↗
PubMedDate not supplied

Dentists' ranking of Medicaid reimbursement rates as a measure of their pediatric Medicaid participation.

The objective of the study was to determine the usefulness of dentists' ranking of Medicaid reimbursement rates as a measure of their participation in the Medicaid program for children. Data were obtained from two mail-in questionnaire surveys of Connecticut dentists, before and after an increase in Medicaid reimbursement rates for children. Dentists ranked acceptability of Medicaid reimbursement rates on a seven-point index, while their participation in the Medicaid program was assessed by whether they acknowledged treating Medicaid children and were currently accepting new Medicaid children into their practices. There was a significant difference (p < 0.0001) in the dentists' ranking of Medicaid reimbursement rates following the rate increase indicating that the index was responsive. Acceptance of new Medicaid children into dental practices was a better measure of active participation in the Medicaid program. Following the increase in Medicaid reimbursement rates, dentists ranking it as acceptable/equivocal were more likely (p < 0.02) to accept new Medicaid children into their practices. In conclusion, the index of dentists' ranking of Medicaid reimbursement rates was a responsive and valid measure of their participation in the Medicaid program.

Attitude of Health Personnel↗
PubMed2002

Long-term follow-up by means of a questionnaire of 109 patients with long-lasting orofacial pain.

The aims were to follow-up, analyse and compare the pain status after 4-9 years with that at the baseline examination of 109 consecutive patients referred to the Pain Group at the Faculty of Odontology in Malmö, Sweden during the period 1988-1993 due to long-lasting orofacial pain. A further aim was to identify predictive factors of significance for pain alteration. 85 (78%) women with a median age of 51 years and 24 (22%) men with a median age of 60 years were included in the study. A survey of the pain status at the follow-up was conducted by means of a mailed questionnaire. The questionnaire covered the following aspects: pain alteration, pain intensity, pain location, medication and education. After one reminder, the non-responding patients were called for a telephone interview. A response level of 85% was obtained. Significant improvements were noted by the patients in the answers of the questionnaire in mainly three areas; the patients answered individually that pain relief had occurred, pain intensity rated on the VAS was lower at follow-up compared to the baseline examination and a decrease in drug use was reported. The responses indicated pain relief for 75% of the patients. However, only 27% of the patients experienced total disappearance of pain. Medication at baseline with opioids, muscle relaxants with central effect, antidepressants, neuroleptics, hypnotics or sedatives was found to be a predictive factor for persistent pain.

Adaptation, Psychological↗
PubMedDate not supplied

Communication about complementary and alternative medicine: perspectives of primary care clinicians.

BACKGROUND: People in the United States are using complementary and alternative medicine (CAM) increasingly while they are also receiving conventional care. National population-based surveys and studies in primary care settings have documented inadequate communication about CAM between patients and their conventional healthcare providers. Most studies about CAM communication have surveyed urban practices and focused on physicians. Information about how physicians and non-physician in rural areas clinicians communicate with their patients about CAM is needed to develop strategies for improving the quality of care for patients in rural areas. OBJECTIVE: To investigate how primary care clinicians in the Kentucky Ambulatory Network (KAN) communicate with patients about CAM and to determine interest in additional education about CAM. METHODS: A self-administered survey was mailed to 112 community clinicians in a research network of largely rural practices. KAN members include primary care physicians, nurse practitioners, certified nurse midwives, and physician assistants practicing in 32 counties in central and eastern Kentucky. RESULTS: Of 102 deliverable surveys, 65 (64%) were returned. Sixty-one (94%) clinicians reported patient CAM use. Few clinicians consistently asked patients about CAM. A positive attitude toward patient CAM use was associated with clinician comfort in advising patients. Most clinicians recommended CAM to patients. Seventy percent of KAN clinicians expressed interest in continuing education about CAM. CONCLUSIONS: Kentucky primary care clinicians are aware of their patients' CAM use and are motivated to learn more about CAM so that they can appropriately advise their patients. They need evidence-based, clinically relevant education about CAM to provide better patient care.

Adult↗
PubMed1995

[Epidemiology of microbial resistance to biocides].

In order to estimate the distribution of bacteria and fungi with an elevated level of resistance to antimicrobial substances, we have analyzed water samples and surveyed institutions presumably concerned with analyses of microbial resistance (university institutes for hygiene, health authorities) by means of questionnaire. A total of 41 water samples was drawn from various aquatic biotopes in the region of Heidelberg. The samples originated from the effluents of a community sewage treatment plant, from the Neckar river, from drinking water supplies and from public swimming pools. The following substance groups were included in a search for bacteria with an elevated resistance to antiseptics and disinfectants: Aldehydes, biguanides, quaternary ammonium compounds (QAC), phenols and halogen. Upon determination of the maximal tolerated concentrations to these antimicrobial agents, samples of treated wastewater effluents showed a considerably higher prevalence of bacteria resistant to formaldehyde, chlorhexidine and QAC. The highest levels of resistance were found in Pseudomonas aeruginosa, Pseudomonas putida, Pseudomonas fluorescens and Enterobacter species. The maximal tolerated level of 0.06 percent formaldehyde by weight was considerably higher than the levels tolerated by the corresponding ATCC reference strains. The highest levels of resistance to a biguanid/QAC preparation were seen in isolates of Alcaligenes species and Providencia species, with a maximal tolerated level of 0.5 volume percent. In addition, several isolates of E. coli and Klebsiella species were observed which showed a considerably higher level of resistance to the biguanide preparation as compared to the corresponding ATCC reference strains. A questionnaire was mailed to a series of institutions and companies presumably concerned with problems of microbial resistance. Responses were in accordance with our own observations, both with regard to the spectrum of bacteria observed and to the antimicrobial substances concerned.

Aldehydes↗
PubMed2001

Predictors of pregnancy-associated change in physical activity in a rural white population.

OBJECTIVE: The objective of this study was to examine the relationship of sociodemographic and psychosocial characteristics and exercise prior to pregnancy to change in physical activity (PA) during pregnancy. METHODS: This study was part of the Bassett Mothers' Health Project (BMHP), a prospective cohort study of women who enrolled for prenatal care in the Bassett Healthcare system between November 7, 1994, and November 15, 1996. Six hundred twenty-two women met the eligibility criteria and were enrolled in the study. Sociodemographic and psychosocial characteristics and exercise behavior were assessed prenatally using the medical record and an anonymous mailed questionnaire. Staged linear regression analysis was used to predict change in physical activity with the psychosocial and sociodemographic characteristics as the independent variables and prepregnancy exercise frequency as a control variable. RESULTS: Women who were older, more educated, and had higher household incomes were more likely to exercise prior to pregnancy (p < .05). Change in PA after becoming pregnant was associated with prepregnancy exercise frequency (p < .001). Women who exercised frequently moderated their activity, while sedentary women maintained or increased their PA after becoming pregnant. Exercise self-efficacy (the belief in one's ability to exercise regularly) and body mass index (BMI) were positive predictors of change in PA (p < .05), while prepregnancy exercise frequency remained significant as a control variable. CONCLUSION: Interventions that aim to help women maintain or increase their PA during the perinatal period should be designed to increase exercise self-efficacy.

Adult↗